Confronting the Healthcare Cost Crisis: Strategies for Transparency and Cost Containment

The escalating costs in health care are a pressing concern, with expenses continually surpassing inflation and workers’ wages. Here we dive into some of the issues, the factors contributing to soaring costs and propose innovative strategies for cost containment.

The Problem:

• Deductibles are increasing at rates that outpace wages.
• Employee populations are “aging”.
• Prescription spending is now about 22% of every dollar spent.
• Premiums continue to “trend” up about 10%.

Employer Spending and the Burden

Health care spending in the United States is projected to reach 20% of GDP by 2025. In 2022, the average premiums for single coverage reached $7,911, with family coverages averaging $22,462 annually. These numbers highlight the financial burden on both employers and employees. 

The Need for Transparency

Just like any other product or service, employers and consumers should have the ability to purchase medical benefits transparently. To this end, there are key regulations that health plans and issuers must comply with:

• Cost Comparison Tool: For plans years beginning in 2024, the internet-based price comparison tool must be available for all shoppable and covered items, services, and drugs. Whereas for 2023 plan years, the cost comparison tool had to cover only 500 items. 
• MRFs: Public posting of in-network rates, out-of-network amounts, and prescription drug prices is mandatory for non-grandfathered health plans. Further guidance will specify a timeline for complying with this requirement. 
• Prescription Drug Reporting: Health plans and issuers must report information about prescription drugs and health care spending to the federal government annually. This reporting process is referred to as the “prescription drug data collection” (or RxDC Report). The annual deadline is June 1, covering data for the previous year. 
• Gag Clause attestations: Health plans and issuers must annually submit an attestation of compliance with the federal prohibition on gag clauses. Attestations are due by December 31 of each year.

Innovative Cost Containment Strategies

To tackle rising costs, several innovative strategies can be adopted:

• Unbundled Services (non BUCA)
  • Create transparency by having each part of your health plan measure against itself. 
• Centers of Excellence
  • Member steerage to quality health care providers who practice efficiently, often leading to reduced total cost of care with improved outcomes. 
• Pharmacy Benefits
  • Eliminate spread pricing, tighten contracts for pass-through rebates & remove hidden fees
• International Rx
  • Save up to 70% on your drug claims by sourcing prescriptions from Tier 1 countries. 
  • Care Management
    • Assist members with care management and redirection through nurse concierge and choice. 

Conclusion

Addressing the healthcare cost crisis requires a multi-faceted approach, emphasizing transparency and innovative cost containment strategies. By adopting these measures, we can work towards a more sustainable and efficient healthcare system that benefits employers, employees, and the entire industry. 

To learn more: 

info@fbplans.com

407-862-5900